Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOCARDITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMed2003

[Surgical therapy of acute endocarditis of the aortic valve with paravalvular abscess. 7 years experiences].

Operative treatment of acute valve endocarditis with paravalvular abscess remains a surgical challenge. The aim of the study was gaining insights into the influence of our surgical strategy on the short- and midterm results. Over a period of 7 years 18 patients underwent surgical treatment of a paravalvular abscess accompanying their acute aortic valve endocarditis. All patients ranged preoperative in the NYHA class IV. Eleven patients suffered from native and 7 from prosthetic aortic valve endocarditis. Staphylococcus aureus was found to have caused the infection in 50% of the cases. Surgical therapy consisted in all patients of thorough resection of the infected tissue followed by reconstruction of the defect with the aid of autologus pericardial patch and replacement of the aortic valve using a prosthesis. Although the rate of complications continued high early lethality remained at 5.5%. Midterm results proved to be very good with a follow-up of 44 month. Both lethality and the reoperation rate stayed at 0%. The operative risk of acute aortic valve endocarditis with paravalvular abscess is high but acceptable. Should a paravalvular abscess be diagnosed during a case of endocarditis urgent surgical therapy is highly advisable even there is only a minor deterioration of the patient' clinical state. Radical abscess debridement in combination with exclusion of the place of resection from circulation using an autologus pericard patch is a necessary condition for achieving good results.

Abscess↗
PubMed2000

Assessment of knowledge of guidelines for the prevention of infective endocarditis amongst clinicians in a teaching hospital.

A significant minority of instances of endocarditis appear to be the result of invasive procedures performed in susceptible patients with underlying cardiac conditions. Absence, or inappropriate administration, of antimicrobial prophylaxis could expose the patient to the development of a potentially lethal infection. This study was formulated, therefore, to assess the knowledge of guidelines for the prevention of infective endocarditis among hospital-based physicians and surgeons. A multiple choice test was developed, including: (1) cardiac conditions at increased risk for development of infection; (2) procedures more likely to be associated with bacteraemia and endocarditis; and (3) type and route of antimicrobials prescribed when endocarditis prophylaxis is indicated. The quality of the test was determined in several ways. Success was defined as a pass rate of 11 of 18 questions (61%). The test was taken by 153 of 251 (60%) physicians employed by the hospital; 95 (62%) passed the test. No significant difference in success rates was found according to sex, professional status or medical school. Internists performed substantially better (with a pass rate of 41 of 53, 77%) than both paediatricians (13 of 26, 50%, P<0.05) and surgeons (41 of 74, 55%, P<0.01). The range of success varied from 100% to 36% according to specialty (P<0.001). The mean score was 69+/-21 in the study group and 94+/-10 in a control group of 20 infectious disease physicians (P<0.001). In conclusion, this study demonstrates the need for improved education of hospital-based clinicians regarding endocarditis prophylaxis recommendations.

Antibiotic Prophylaxis↗
PubMed1982

Pathology of active infective endocarditis: a necropsy analysis of 192 patients.

Successful treatment of infective endocarditis often requires cardiac valve replacement during the active infection. This is especially the case with aortic valve infection, and with infection of valve prostheses in either the aortic or mitral position. Valve excision with or without replacement, however, is also sometimes required for tricuspid valve infection (1). This discussion will focus on the morphologic aspects of active infective endocarditis involving both right and left-sided native cardiac valves. It will also examine certain morphologic aspects of mechanical and bioprosthetic valve substitutes. The information is derived from necropsy examination by the authors of 192 patients with active infective valvular endocarditis (Table 1). Of the 192 patients, 129 were described in an earlier publication (2). Patients with infective endocarditis complicating congenital heart disease with a shunt (6 patients), and those with infective endocarditis following valvulotomy (4 patients) are omitted from this analysis.

Adult↗
PubMed1995

[The clinical importance of scintigraphy with the murine monoclonal antigranulocyte antibody BW 250/183 for the diagnosis of prosthesis-related endocarditis].

Thirty-eight patients (16 men, 22 women; median age 62.5, range 7 to 80 years) were enrolled in a prospective study to assess the clinical utility of radioimaging using the antigranulocyte antibody BW 250/183 in suspected valve endocarditis. Eighteen patients had prosthetic valve endocarditis according to clinical criteria (surgical confirmation in 8 patients), the remaining 20 patients served as controls. All patients underwent transthoracic and transesophageal echocardiography. Eight to 10 MBq of technetium-99m-labeled antibody were intravenously injected and single-photon emission computed tomography (SPECT) of the thorax was performed after 20 to 24 h. Echocardiography revealed pathological findings in 16 of 18 patients with endocarditis (sensitivity 89%) and was false positive in one of 20 control subjects (specificity 95%). Scintigraphy was true positive in 14 of 18 patients with endocarditis (sensitivity 78%) and false positive in three of 20 control subjects (specificity 85%). Scintigraphy was true positive in the patients with false negative echocardiography and vice versa (sensitivity for both methods combined 100%, specificity 80%). In all five follow-up patients, scintigraphy became negative parallel to clinical improvement. This suggests that scintigraphy indicates the floridity of the inflammatory process. In clinically suspected prosthetic valve endocarditis with equivocal echocardiographic findings, SPECT using the antigranulocyte antibody BW 250/183 may provide valuable additional diagnostic information.

Adolescent↗
PubMed1984

Right-sided infective endocarditis as a consequence of flow-directed pulmonary-artery catheterization. A clinicopathological study of 55 autopsied patients.

We studied 142 consecutively autopsied patients prospectively to determine the frequency and clinical importance of right-sided endocardial lesions in patients who had undergone flow-directed pulmonary-artery catheterization within one month of death. Of the 55 catheterized patients, 29 (53 per cent) had one or more right-sided endocardial lesions: 12 (22 per cent) had subendocardial hemorrhage, 11 (20 per cent) sterile thrombus, 2 (4 per cent) hemorrhage and thrombus, and 4 (7 per cent) infective endocarditis. Of 41 lesions seen in the 29 patients, 23 (56 per cent) were located on the pulmonic valve, 6 (15 per cent) on the tricuspid valve, 6 (15 per cent) in the right atrium, 4 (10 per cent) in the right ventricle, and 2 (5 per cent) in the main pulmonary artery. All four patients with infective endocarditis had had positive antemortem blood cultures while the catheter was in place, but in only one had the diagnosis of endocarditis been suspected clinically. The unusual locations of the infected vegetations (on the pulmonic valve in three and in the right atrium in one) and the similar location of the uninfected lesions suggest that the infective endocarditis was a consequence of catheter-induced endocardial damage with concurrent or subsequent bacteremia. Among the 87 non-catheterized patients, there were two subendocardial hemorrhages and one resolving right atrial thrombus. We conclude that endocardial damage from flow-directed pulmonary-artery catheterization is common and that right-sided infective endocarditis should be suspected in bacteremic catheterized patients.

Adolescent↗
PubMed2001

Cardiac conduction abnormalities in endocarditis defined by the Duke criteria.

BACKGROUND: Cardiac conduction abnormalities occur in endocarditis and have been associated with infection extension and increased mortality. There have been no prospective studies of electrocardiographic (ECG) conduction changes in endocarditis. We examined the incidence of ECG changes in a large prospective cohort with suspected endocarditis and correlated changes with echocardiographic evidence of invasive infection and mortality. METHODS: One hundred thirty-seven of 1396 (10%) suspected cases of endocarditis were classified as "definite" or "possible" by the Duke criteria and had an interpretable ECG. ECG conduction changes were classified as old (pre-existing hospitalization), new (evident on admission or developed during hospitalization), or indeterminate. New or indeterminate abnormalities were considered "ECG conduction changes." Echocardiogram results were reviewed to identify infected valves and invasive infection. RESULTS: ECG conduction changes were present in 36 of 137 (26%) patients. Patients with ECG conduction changes were more often male (69% vs 46%, P =.005) and had prosthetic valves (47% vs 23%, P <.001). There were no significant differences in microbiology results or treatment with cardiac surgery. In 76 (55%) patients, at least one infected valve was identified by echocardiography; 15 of 76 (20%) patients were determined to have evidence of invasive infection. Eight of 15 (53%) invasive infections exhibited ECG conduction changes compared with 16 of 61 (26%) isolated valve infections (P =.046). Eleven of 36 (31%) patients with ECG conduction changes died during hospitalization compared with 15 of 101 (15%) patients without changes (P =.039). CONCLUSIONS: ECG conduction changes commonly occur in endocarditis despite more sensitive diagnostic criteria and are associated with increased mortality and invasive infection.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Stenotrophomonas maltophilia endocarditis of prosthetic aortic valve: report of a case and review of literature.

Stenotrophomonas Maltophilia (previously known as Xanthomonas maltophilia and Pseudomonas maltophilia ) is an aerobic, nonfermenting, gram-negative bacillus, which has emerged as a serious nosocomial pathogen in patients with compromised immunity. It is a rare cause of endocarditis with only 20 cases previously reported in medical literature. The risk factors associated with S maltophilia endocarditis include intravenous drug abuse, dental treatment, previous cardiac surgery, and infected intravascular devices. S maltophilia is resistant to multiple antibiotics, which leads to frequent therapeutic failures. Although the optimal antibiotic treatment for S maltophilia endocarditis remains unknown, most of the patients received 2 or more antibiotics. We report a case of S maltophilia endocarditis of prosthetic aortic valve, associated with a painless aortic dissection, that responded well to a combination of ciprofloxacin and chloramphenicol. The literature is reviewed to elaborate the disease characteristics, the treatments used, and the prognosis of the S maltophilia endocarditis.

Aortic Dissection↗
PubMed2006

Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections.

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Adult↗
PubMed2006

Endocarditis at a tertiary hospital: reduced acute mortality but poor long term prognosis.

The outcome in 132 patients with infective endocarditis diagnosed in accordance with the Duke criteria at a tertiary hospital in Denmark in the period 1998-2000 is reported. The total in-hospital mortality was 15%. Indications are that in-hospital mortality over the last decade has been reduced by around a quarter. Mortality after 3 months was 17% (CI 29%), after 3 years 32% (CI 16-47%) and after 5 years 39% (CI 22-55%). This 5-years mortality was 5 times that of an age and gender matched background population. After follow-up for 5-8 y, mortality was highest for prosthetic valve endocarditis (63% vs. 39%, p = 0.05). Heart surgery was performed in 51% of the cases. Patients who underwent surgery had a lower mortality at follow-up (36% vs. 52%, p = 0.04). The 5-year mortality was 30% (CI 9-52%) for patients treated with surgery and 48% (CI 23-72%) for patients treated without surgery. In multivariable analysis surgery was not an independent predictor for lower long-term mortality. Surgery was however an independent predictor for lower intermediate-term mortality. It is concluded that surgery may be associated with lower short- and intermediate-term mortality, while the effect might decline in the long-term. High age, prosthetic valve endocarditis, and Staphylococcus aureus endocarditis were independent predictors for high mortality. Although improvements have occurred over recent years, infective endocarditis is still a high mortality disease.

Adult↗
PubMed1998

Isolated right-sided Bartonella quintana endocarditis in an immunocompetent adult.

Bartonella quintana is a recently recognized cause of culture-negative left-sided endocarditis. We report a case of isolated tricuspid endocarditis caused by B. quintana in a 65-year-old alcoholic man, who also had immune-complex glomerulonephritis. B. quintana was established as the cause of the endocarditis based on serological tests and on failure of extensive efforts to isolate an alternative organism. The patient improved gradually on antibiotic therapy and did not require surgery. To our knowledge, this is the first report of isolated right-sided endocarditis caused by B. quintana. Although uncommon, Bartonella should be considered in patients with isolated right-sided culture-negative endocarditis.

Aged↗
PubMed1998

Pneumococcal endocarditis is not just a disease of the past: an analysis of 16 cases diagnosed in Denmark 1986-1997.

To remind clinicians and clinical microbiologists of the clinical features and therapeutic aspects of pneumococcal endocarditis, patients with pneumococcal endocarditis from 1986 to 1997 were identified via an enquiry to clinical microbiologists across Denmark. For all patients records were reviewed to confirm the diagnosis of pneumococcal endocarditis, and the clinical course, therapy and outcome were analysed. 16 patients with definitive pneumococcal endocarditis were found. All pneumococcal isolates were sensitive to penicillin. 15 patients had no previously known cardiac valvular disease, 10 patients had X-ray-proven pneumonia and 5 had meningitis. The aortic valve was affected in 13 patients, of whom 12 developed aortic insufficiency and 11 cardiac failure. Of 7 patients who underwent surgery, 6 needed immediate cardiac valve replacement. The 30-day case fatality rate was 19% (95% confidence limits 4-46%). Pneumococcal endocarditis must be considered when treating patients with pneumococcaemia. The most important clue to the diagnosis is a significant murmur and development of heart failure. Evaluation by transoesophageal echocardiography is helpful in determining the diagnosis and assessing the need for surgical intervention. With appropriate antibiotic therapy, close observation and cardiac valve replacement if necessary, the prognosis is better than recorded in earlier studies.

Adult↗
PubMed1982

Infective endocarditis in thirteen children: a retrospective study (1974-1981).

Thirteen children (11 African, two Indian) with infective endocarditis are described. Rheumatic heart disease was present in nine of the children and was therefore a major determinant of infective endocarditis whereas a congenital cardiac abnormality (Fallot's tetralogy) was detected in only one child. Staphylococcus aureus was the commonest infecting organism, being found in five children, and Streptococcus viridans was isolated in one. Fever, murmurs and anaemia were the most frequent clinical expression of the disease. Renal problems were trivial except in two children with endocarditis due to Staphylococcus aureus in whom they were serious. Staphylococcus aureus endocarditis was uniformly fatal. Among eight children who died neurological complications caused death in four. The patterns of infective endocarditis in developed and Third-World countries are compared.

Child↗
PubMed2004

Culture-negative Bartonella endocarditis in a patient with renal failure: the value of molecular methods in diagnosis.

Members of the genus Bartonella are increasingly recognised as a cause of culture-negative endocarditis, particularly in those patients with underlying risk factors (e.g., homelessness and alcoholism (B. quintana) or valvulopathy and cat ownership (B. henselae). The aortic and mitral-valves are most commonly involved. Here, a case is reported of culture-negative right-sided endocarditis, without any of the above risk factors, due to Bartonella sp. in a 69-year-old man who presented with acute renal failure. The diagnosis was made using a broad-range 16S rRNA polymerase chain reaction (PCR) technique and direct automated sequencing on a peripheral blood sample, which was subsequently confirmed serologically. A review of the literature on Bartonella endocarditis is also presented. Molecular laboratory methods using peripheral blood or blood cultures may be very useful in the diagnosis of causal agents in culture-negative endocarditis and add further support to the recently inclusion of molecular (PCR) diagnosis, as a major Duke's criterion, for the diagnosis of infective endocarditis.

Acute Kidney Injury↗
PubMed2003

Cardiac valves in patients with Q fever endocarditis: microbiological, molecular, and histologic studies.

The pathologic features of Q fever endocarditis, which is caused by Coxiella burnetii, were histologically evaluated in cardiac valves from 28 patients. We used quantitative image analysis to compare valvular fibrosis, calcifications, vegetations, inflammation, and vascularization due to Q fever endocarditis with that due to non-Q fever endocarditis and valvular degeneration. We also studied the presence of C. burnetii in valves by immunohistochemical analysis, culture, and polymerase chain reaction (PCR). Histologically, Q fever endocarditis was characterized by significant fibrosis and calcifications, slight inflammation and vascularization, and small or absent vegetations. Despite antibiotic treatment, non-statistically significant variations at the histologic level were observed. These pathologic features could be confused with noninfectious valvular degenerative damage. We found that the detection of C. burnetii in cardiac valves by immunohistochemical analysis, culture, and PCR decreased significantly only after 1 year of antibiotic treatment, which emphasizes the long persistence of this organism in valve tissues. Pathologic and immunohistochemical analyses may contribute to the diagnosis of Q fever endocarditis.

Adult↗
PubMed2004

Cardiac valves in patients with Whipple endocarditis: microbiological, molecular, quantitative histologic, and immunohistochemical studies of 5 patients.

The pathological features of Whipple endocarditis, which is caused by Tropheryma whipplei, were histologically evaluated in cardiac valves from 5 patients. We used quantitative image analysis to compare the valvular fibrosis, calcifications, vegetations, inflammation, and vascularization due to Whipple endocarditis with those due to non-Whipple endocarditis and degenerative valves. We also studied the presence of T. whipplei in valves by immunohistochemical analysis, culture, and polymerase chain reaction (PCR). In histologic analysis, Whipple endocarditis was characterized by significant fibrosis, a lack of calcifications, slight inflammation and vascularization, and vegetations of intermediate size. Inflammatory infiltrates consisted mainly of foamy macrophages and lymphocytes. We found that the detection of T. whipplei in cardiac valves, by immunohistochemical analysis, was correlated with the detection of the bacterium by culture and PCR. We report, for the first time, the immunodetection of T. whipplei in a surgically removed arterial embolus. Pathological and immunohistologic analyses may contribute to the diagnosis of Whipple endocarditis.

Adult↗
PubMed2005

Bacteriological outcome after valve surgery for active infective endocarditis: implications for duration of treatment after surgery.

BACKGROUND: There has been no systematic evaluation of outcome after surgery for infective endocarditis with respect to duration of antibiotic treatment. METHODS: We performed a retrospective chart review of episodes of valve surgery for active infective endocarditis at Green Lane Hospital (Auckland, New Zealand) for 1963-1999. We recorded the duration of antibiotic treatment before and after valve surgery; the extent of infection at operation; Gram stain, culture, and histopathological testing results for valve samples; and the bacteriological outcome after surgery. The primary outcome measure was relapse, defined as endocarditis due to the same species within 1 year after surgery. RESULTS: For the 358 patients in our study, the median duration of follow-up was 4.8 years. Thirty-two patients (9%) had 36 subsequent episodes of endocarditis. Relapse occurred after 3 (0.8%) of the operations (95% CI, 0.2%-2.0%). Relapse of infection was unrelated to the duration of antibiotic treatment before or after surgery, positive valve culture results, positive Gram stain results, or perivalvular infection. Since 1994, we have reduced the duration of antibiotic treatment by approximately 7 days for those with positive valve culture results and by approximately 14 days for those with negative valve culture results, without any increase in the number of relapses. CONCLUSIONS: Relapse is an uncommon event following surgery for endocarditis. Commonly suggested indications for prolonging postoperative treatment are not associated with higher relapse rates, and their relevance is debatable. We conclude that it is unnecessary to continue treatment for patients with negative valve culture results for an arbitrary 4-6-week period after surgery. Two weeks of treatment appears to be sufficient, and, for those operated on near the end of the standard period of treatment, simply completing the planned course should suffice.

Aged↗
PubMed2005

Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature.

BACKGROUND: Endocarditis due to vancomycin-resistant enterococci (VRE) is rare, and the literature consists almost exclusively of reports of single cases. METHODS: We report a case of VRE prosthetic valve endocarditis and review 18 cases of native and prosthetic valve VRE endocarditis reported in the literature. RESULTS: The majority of cases were due to Enterococcus faecium. Nearly all of these infections were hospital acquired, and the vast majority of patients had significant underlying disease processes, including dialysis and transplantation. More than three-quarters of cases were left-sided, and the aortic valve was most commonly involved. Peripheral stigmata of endocarditis were not reported in any of the cases. Approximately 40% of patients developed cardiac complications. Nearly three-quarters of patients survived, despite the difficulties associated with providing bactericidal antimicrobial therapy, and only 4 patients underwent valve replacement. CONCLUSIONS: VRE endocarditis is an uncommon nosocomial infection that affects patients with significant comorbid conditions. Most cases are due to E. faecium, and the aortic valve is involved in at least one-half of cases. One-third of patients require surgical treatment. Optimal antimicrobial therapy remains undefined, but an attempt to identify bactericidal combination therapy should be sought.

Adult↗
PubMed1997

Polyclonal staphylococcus endocarditis.

Coagulase-negative staphylococcus (CNS) is the most frequent cause of nosocomial bacteremia and prosthetic valve endocarditis. CNS bacteremia can be polyclonal. No data exist on the clonality of CNS causing endocarditis. We present a case of CNS aortic homograft endocarditis in which at least five different genotypes of CNS were identified in initial blood-culture isolates by genomic macrorestriction enzyme analysis and pulsed field gel electrophoresis. Since the polyclonality was accompanied by differences in antibiotic susceptibility, this observation may have important consequences for the treatment of CNS endocarditis. Because of the parallels in the pathogenesis of CNS prosthetic valve endocarditis and CNS infections of a variety of other prosthetic devices, it might also have consequences for CNS prosthetic device infections in general. We suggest that antibiotic susceptibility testing of just one blood-culture isolate may be insufficient.

Coagulase↗